H T A H T I A E

H T A H T I A E D I L G N W E D

GRIEF AND DYING Final stage of life is death § Ends unexpectedly § Must come to grips with terminal illness

THE NURSE AND DYING https: //www. youtube. com/watch? v=4 o 7 w 3 i. OV_WM

GRIEF AND DYING Stages of grief § Denial § Anger § Bargaining § Depression § Acceptance

GRIEF AND DYING Denial § Reject the idea

GRIEF AND DYING Anger § Hostility directed at anyone they come in contact with

GRIEF AND DYING Bargaining § Setting goals § Making promises to reach goals

GRIEF AND DYING Depression § Quiet withdrawal § Spoken regrets § Great sadness

GRIEF AND DYING Acceptance § Slowly separate from the world § Rest in peace and dignity

GRIEF AND DYING Role of health care workers

GRIEF AND DYING Special needs of terminal patients § Physical § Emotional and social § Spiritual

GRIEF AND DYING Physical needs § Kept comfortable § Oral care, fluid intake and skin care § Report changes

GRIEF AND DYING Emotional and social needs § Provide privacy § With family as much as desired § Listen if needed § Be genuine

GRIEF AND DYING Spiritual needs § Cooperate with patient’s clergy § Assist in finding a clergy or chaplain § Remember it is their right to believe whatever feels right to them

GRIEF AND DYING Hospice care philosophy § Death is a natural process § Control pain § Provide for psychological, spiritual, and social needs of the patient and family § Provide legal and financial counseling

GRIEF AND DYING Hospice care services § Care for patients with 6 months or less to live § Nursing care under supervision of physicians and nurses § Care in hospice facility, long-term care facility or at home § Support patient and family § Provide counseling to family after death

DEATH AND POSTMORTEM CARE Signs of approaching death § Less responsive § Body functions slow down § Lose of voluntary and involuntary muscle control § Involuntarily void or defecate § Jaw may drop § Breathing becomes irregular, shallow and laborious § Circulation slows, extremities become cold and mottled § Pulse becomes rapid then weaker § Skin becomes pale § Eyes stare and do not respond to light

SIGNS OF APPROACHING DEATH Changes in sensory functions and ability to speak §Vision §increased secretions in corner of eyes §blurred vision §failing vision §no eye movement/staring DHSR APPROVED CURRICULUMUNIT 12 18

SIGNS OF APPROACHING DEATH Changes in sensory functions and ability to speak (continued) §Speech §becomes difficult §hard to understand §may be unable to speak §Hearing - last function to be lost DHSR APPROVED CURRICULUMUNIT 12 19

SIGNS OF APPROACHING DEATH Changes in circulation and muscle tone §Circulation §fails §heat gradually lost from body DHSR APPROVED CURRICULUMUNIT 12 20

SKIN CHANGES §hands and feet cold to touch and mottled §face becomes pale or gray and mottled §perspiration may increase (diaphoresis)

SIGNS OF APPROACHING DEATH Changes in circulation and muscle tone (continued) §Muscle tone §body limp §jaw may drop §mouth may stay partly open DHSR APPROVED CURRICULUMUNIT 12 22

SIGNS OF APPROACHING DEATH Changes in Vital Signs §Respirations §slower §shallow §labored §may experience dyspnea, apnea, Cheyne-Stokes §mucous collects in the throat and bronchial tubes (death rattle) DHSR APPROVED CURRICULUMUNIT 12 23

CHEYNE STOKES RESPIRATIONS https: //www. youtube. com/watch? v=Cr. Kfmfu. P 9 l 4&safe=active

SIGNS OF APPROACHING DEATH Changes in Vital Signs (continued) §Pulse §rapid §weak and irregular §Blood pressure drops §Temperature §elevated §subnormal DHSR APPROVED CURRICULUMUNIT 12 25

SIGNS OF APPROACHING DEATH Urinary and anal incontinence Decreased peristalsis, abdominal distention Release of flatus Decreased pain Loss of consciousness DHSR APPROVED CURRICULUMUNIT 12 26

DEATH AND POSTMORTEM CARE During death § Notify head nurse § Remain respectful § Use soft, kind words

DEATH AND POSTMORTEM CARE Moribund changes § Pupils dilated § No pulse or respiration § Heat lost § Urinate, defecate or release flatus § Lowest parts of body turn purple § Rigor mortis § Odor

DEATH AND POSTMORTEM CARE Religion and death § Ask family and clergy what is acceptable

LESSON 2 – DEATH AND POSTMORTEM CARE Postmortem care § Treat body with respect and dignity at all times § Use standard precautions